Why I Write About Peer Support and Peer Support Specialists

 I am a clinical psychologist and I am not a Peer Support Specialist.  How did I come to be an enthusiastic supporter of the expansion of peer support and Peer Support Specialists? 

I recently retired after a 35-year career in the mental health services of the Veterans Administration.  As part of my work as a VA clinical psychologist, I was asked to be part of a research program that evaluated how effective common mental health interventions were.  These are interventions that are provided to thousands of people every day – therapy, residential treatment, etc.  The field always assumed that these interventions work very well – but there was limited careful data. 

In doing that work, I became increasingly aware that most of our interventions are not beneficial for many people.  Rates of successful outcome tend to range between 50% and 80% for even our best programs.  More concerning is the evidence that many people don’t participate in treatment or wait for years before entering, and that after treatment, many people lose the benefits of treatment that they had achieved.  The more I learned, the more obvious was the need to find ways to significantly improve mental health programs and interventions.

At around this time, the Veterans Administration started hiring Peer Support Specialists.  As a program manager, I was immediately interested in the potential for this new group of providers to improve our outcomes.  What caught my eye initially was a few unique benefits of including Peer Support Providers in clinical care:

1.      They have personal experience about elements of recovery that clinicians do not know about.  The training of clinicians covers only parts of the experience of recovery. Peer Support Specialists have needed information for clients and for clinicians and are required by their job to share that information.

 2.      Peer Support Specialists are the voice of success.  Clinical programs are full of participants who have relapsed multiple times.  It is easy for participants and for clinicians to start to feel that “no one ever gets better”.  This is simply an illusion caused by the fact that the clients who do get better don’t come back – clinicians and clients don’t see them again.  By bringing in Peer Support Specialists, clients and clinicians can see people who have succeeded and hear their input into current care.

 3.      The presence of Peer Support Specialists reminds staff and administrators of the goal of their work.  When you spend your workdays providing clinical care to what can feel like an endless stream of people, it is possible (even probable) to lose track of what you are doing this for.  Having a colleague who is someone in recovery makes it very clear what that work is for and why it is important to do that work with commitment and energy.

Once we started hiring and including Peer Support Specialists, I noticed some additional advantages:

• When Peer Support Specialists were part of clinical meetings, the clinicians changed the way they talked about the clients.  There were fewer negative comments about clients, fewer dark jokes about negative outcomes.  Those clinicians who tended to say disrespectful things about clients tended to be quiet. 

•  Clients started telling Peer Support Specialists about what was not working and what they didn’t like about services.  The Peer Support Specialists then fed this information back to the clinical team and the team made changes.  Many of these changes were small, but some were very large.  At one point a Peer Support Specialist reported to me that many clients were reporting that a residential program that we sent people to, involved staff who were often insulting to the participants, and practices like watering down the beverages to save money.  Clients had been afraid to share this feedback with clinicians, but the presence of Peer Support Specialists helped empower them.  We looked into the complaints, found solid evidence that they were true, and broke the contract with that provider which promptly went out of business.

•  As Peer Support Specialists got comfortable in their role, they became a key source of new ideas for improving programming.  Because they did not get trained as a clinician, they had “fresh eyes” to see potential ways to improve programming that other clinicians did not see.  We started making exciting new changes based primarily on new ideas provided by Peer Support Specialists.

As a manager, Peer Support Specialists proved their value in helping improve the programs that I was responsible for.  At the same time, I started to be aware of some threats to the success of this valuable new group of team members. 

1.      Some clinicians did not understand the value of Peer Support Specialists, and some felt threatened.  For example, at one staff meeting a clinician stated that hiring Peer Support Specialists was simply a way to eliminate clinicians and to reduce costs.

 2.      The lack of formal training set Peer Support Specialists up for mistakes.   Healthcare is a complex setting to work it.  There are many different types of professions and many guidelines.  Clinicians receive years of training that helps them work successfully in a healthcare setting.  Peer Support Specialists were receiving very little, if any real training.  The predictable result was that they were making more mistakes in how they performed their job.  Those clinicians who did not understand the value of Peer Support
Specialists were vocal in pointing out those mistakes and using them to argue that we should not hire peers.

 3.      I realized that the graduate training that clinicians go through had served to screen out people who were not responsible and did not have a good work ethic.  Graduate school requires that you be conscientious, organized and self-motivated. By simply hiring people who qualified as Peer Support Specialists, we did not have an effective screen to ensure that all of those we hired were responsible hard-working peers.  I personally hired a few Peer Support Specialists who were not responsible enough to have made it through graduate school, and who were not good Peer Support Specialists.  Again, this represented a risk to the development of Peer Support Specialists because poor workers hurt the reputation of the positive workers.

As a psychologist, I became convinced that Peer Support Specialists were a game changer in a field that had modest success rates and so needed big changes.  I worked closely with Peer Support Specialists and saw the great value they bring to clinical settings.  I also became aware of the threats to successful Peer Support services, including the resistance of some clinicians, the lack of sufficient basic training to work in the complex healthcare setting, and the lack of a natural filter to eliminate people who want to be Peer Support Specialists but who do not have the basic work habits to be successful.  My support for this profession and this group evolved out of this experience.

There is a political issue related to my writing.  I am not a Peer Support Specialist and I have not worked as a Peer Support Specialist.  Wouldn’t it be better to leave this to Peer Support Specialists to write about?

I want Peer Support Specialists to be the key voice in the development of this field.  This makes sense practically and politically.  At the same time, if I can help the field grow by sharing my insights, I feel that this is a valid way to the fulfil my own commitment to help the overall mental health field to improve in its ability to better serve our clients.  I have worked with, and written about the work of psychiatrists, social workers, nurses, mental health counselors, vocational counselors, and occupational therapists. 

I have considered becoming a Peer Support Specialist.  Like many mental health providers, I have my own personal lived experience with mental illness both in my life and in my family.  As a psychologist, I do share some of that information with clients as appropriate, but that is rare.  As a Peer Support Specialist, I could share more and be helpful in a different way.

At this point in my career, I have decided for practical reasons not to pursue certification as a Peer Support Specialist.  I will continue to be involved in partnering with Peer Support Specialists and to advocate for the expansion of their role and their profession.  I am certain that more voices will grow from within the field of Peer Support Specialists and I welcome that.  At the same time, I feel I and other clinicians can be a helpful voice from within our field, arguing for the importance of peer support in virtually every aspect of clinical care. 

KEY WORDS: Peer Support Specialist, Recovery, Peer Support, Peer Support Training, Peer Support Certification, Peer Support Jobs